SEEK™: A Program to Implement Evidence-Based Practice and Transform Oncology Nursing Practice.

BACKGROUND: Evidence-based practice (EBP) uses current and best evidence, clinical expertise, and patient values to drive clinical decisions. Organizations struggle with building and sustaining an EBP-focused culture. OBJECTIVES: This article shares the development and implementation of SEEK™ (Spirit of Inquiry, Expanding EBP Knowledge), an educational initiative on how to apply EBP processes at a Magnet®- and National Cancer Institute- designated comprehensive cancer center. METHODS: Participants learned principles of the EBP process using didactic sessions, small group exercises, and article critiques. With mentor guidance, participants searched for and appraised evidence, proposed interventions, designed an implementation plan, and developed metrics to measure results. FINDINGS: To date, 56 SEEK projects are in various stages of development and implementation. Based on postprogram survey results, SEEK participants and mentors demonstrated increased EBP knowledge.

What Are the Ethical Obligations Related to a Request for Nonbeneficial Treatment?

It is common for a headline to proclaim promising results of a new cancer drug and for medical oncology offices to be flooded with calls from patients hoping that this new "miracle" drug offers them a chance of cure. Conf.

Association of autism spectrum disorder with Waardenburg syndrome in a toddler.

Waardenburg syndrome is a rare genetic condition with an incidence of 1 in 212 000. The condition is classically associated with distinctive facial features, congenital hearing loss and pigmentary changes of the hair, iris and skin. There is a paucity of literature about the association of neurodevelopmental conditions with this syndrome. We present a toddler with Waardenburg syndrome type 1 who was referred to our service for developmental delay concerns. The child was diagnosed with the condition at birth, had distinctive facial features, but the hearing was normal. The child's father also shares a similar mutation. Following a multidisciplinary assessment, the child was diagnosed to have autism spectrum disorder with possible regression. We acknowledge that there may not be a causal relationship between autism spectrum and Waardenburg syndrome. However, this highlights the need for developmental surveillance among children diagnosed with Waardenburg syndrome and to consider its association with neurodevelopmental conditions.

Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach.

PURPOSE: To evaluate the utility of the PI-QUAL score in assessing protocol changes aimed to improve image quality from a non-endorectal coil prostate MR imaging protocol during a 9-month quality improvement (QI) project and to quantify the inter-reader agreement of PI-QUAL scores between radiologists, technologists, and physicists. METHODS: This retrospective study audited 1,012 multiparametric prostate MRI examinations as part of a national QI project according to the PI-QUAL standard. PI-QUAL scores were used to inform MR protocol changes. Following the project, 4 radiologists, 2 technologists, and 1 medical physicist collectively audited an additional set of 150 examinations to identify statistical improvements in image quality using the two-tailed Wilcoxon rank sum test. The improvements due to individual protocol changes were assessed among subsets of the 1,012 examinations which compared examinations occurring before and after the isolated protocol change. Inter-reader variability was assessed using the percent majority agreement and the average standard deviation of PI-QUAL scores between evaluators. RESULTS: During this QI project, PI-QUAL scores improved from 3.67 ± 0.75 to 4.16 ± 0.59 (p < 0.01) after implementing a series of protocol changes. Among a subset of 451 cases, we found that adopting R/L rather than A/P phase encoding reduced distortion in diffusion-weighted imaging (DW) from 21.6% (41/190 A/P phase encoded cases) to 11.5% (30/261 R/L phase encoded cases) (p < 0.01). Similarly, in the same 451 cases, adopting R/L phase encoding in T2WI reduced breathing motion artifacts from 34.6% (94/272 A/P phase encoding cases) to 12.8% (23/179 R/L phase encoding cases) (p < 0.01). DWI wraparound artifact was mitigated by employing a full-pelvis shim and enabling the abdomen shim option. The occurrence of low signal-to-noise ratio was reduced from 19.4% (19/98 cases without a weight-based threshold) to 6.3% (10/160) by instituting a weight-based threshold for using an endorectal coil (p < 0.01). The percent majority agreement was similar between radiologists, technologists and physicists, and all evaluators combined (72%, 77%, and 67%, respectively). CONCLUSIONS: PI-QUAL can evaluate image quality changes resulting from protocol optimizations at both the exam- and series-levels. With training, radiologists, technologists, and physicists can perform PI-QUAL scoring with similar performance. Broadening the scope of the quality improvement team can result in meaningful and lasting change.

Ethics Education: Using Storytelling to Teach Ethics to Novice Oncology Nurses.

BACKGROUND: Oncology nurses face unique challenges in the care of patients from culturally diverse backgrounds. Culture, values, and preferences play important roles in patient decision-making regarding goals of care and treatment. OBJECTIVES: This article describes the content and outcome of an educational seminar for nurse residents, which uses storytelling to highlight the relationship between dynamic cultural influences and ethical decision-making. METHODS: A 75-minute didactic seminar using storytelling, role-playing, and simulation was incorporated into a nurse residency program. Stories illustrate the role of oncology nurses in protecting and advocating for vulnerable patients, respecting and accommodating cultural differences, and increasing self-awareness of personal values that may influence decisions. Tests were administered to participants before, immediately after, and three months after the seminar to measure changes in knowledge. FINDINGS: Over one year, 107 novice oncology nurses, in five cohorts, attended the seminar. Results demonstrated an overall increase and sustainment of knowledge regarding ethical decision-making in nurse residents and illustrated the effectiveness of storytelling as a method to promote ethical decision-making among staff.

Staff Experiences at a New York City Medical Center During the Spring Peak of the Covid-19 Pandemic: A Qualitative Study.

Purpose: In March-April 2020, New York City was overwhelmed by COVID-19 infections, leading to substantial disruptions in nearly all aspects of care and operations at most local hospitals. This qualitative study of a quaternary, urban oncology hospital investigated the effects of these disruptions upon a professionally diverse cohort of its employees, including physicians, nurses, respiratory therapists, pharmacists, security guards, histology technicians, and environmental services workers. Methods: The participant pool were selected through a combination of purposive and random sampling methodology and coders performed a thematic content analysis of open-ended responses. Results: Analysis revealed several important themes, including concerns about exposure for self and others; patient care as a source of both satisfaction and stress; psychological consequences of uncertainty and ambiguity; family as sources of both comfort and apprehension; the importance of adequate institutional communication; and support from colleagues. Conclusion: Results and analysis provide suggestions for institutional policies and initiatives in the event of a COVID-19 surge or another public health crisis. Administrative efforts should aspire to establish, strengthen, and promote interdisciplinary and interdepartmental efforts to address, and mitigate workplace and personal stressors. through timely and transparent communications, consistent clinical guidance and information about changes in hospital policies and supplemental employee assistance.

What Should Clinicians Do When a Patient's Autonomy Undermines Her Being Treated Equitably?

Language and cultural barriers can impede communication between patients and clinicians, exacerbating health inequity. Additional complications can arise when family members, intending to protect their loved ones, ask clinicians to lie or not disclose to patients their diagnoses, prognoses, or intervention options. Clinicians must express respect for patients' and families' cultural, religious, and social norms regarding health care decision making, but they might also be ethically troubled by some decisions' effects on patients' health outcomes. This article suggests strategies for clinicians trying to overcome linguistic and cultural barriers to equitable patient care.

Safe and Effective Standards of Care: Supporting the Administration of T-VEC for Patients With Advanced Melanoma in the Outpatient Oncology Setting
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BACKGROUND: Talimogene laherparepvec (T-VEC) is the first oncolytic virus (OV) to demonstrate therapeutic benefit for the treatment of advanced melanoma. As a live virus, the use of T-VEC in medical and surgical outpatient clinics posed challenges. 
. OBJECTIVES: The purpose of this article is to describe the challenges faced when introducing an OV treatment into outpatient clinics and the processes implemented to ensure safety for patients, caregivers, and staff across the care continuum. 
. METHODS: An interdisciplinary team of experts developed and implemented new practices and workflows to support the administration of T-VEC in the outpatient setting. Clinical staff were educated on this new treatment, its indications and side effects, and the practice standards created to support its use. 
. FINDINGS: T-VEC posed safety and logistical challenges that were successfully addressed and implemented. To date, 16 patients with locoregionally advanced melanoma have been treated with T-VEC. No adverse events occurred related to preparation or administration, which opens the door for similar therapies in the future.

Immunotherapy Administration: Oncology Nursing Society Recommendations
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As the use of immunotherapeutic agents increases in single-agent and multimodality treatment regimens, oncology nurses face the challenge of administering and caring for patients receiving new and unique agents. Oncology Nursing Society clinical staff and clinical nurses collaborated to produce a set of recommendations to educate nurses involved with the monitoring of patients receiving immunotherapy on administration procedures and safe handling of these agents to ensure patient and staff safety and to reduce risk of error. The recommendations are meant to provide clinical nurses with a framework on which to build policies and procedures for administering new treatment modalities.
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Evaluation of MRI acquisition workflow with lean six sigma method: case study of liver and knee examinations.

OBJECTIVE: The purpose of this investigation was to assess workflow for medical imaging studies, specifically comparing liver and knee MRI examinations by use of the Lean Six Sigma methodologic framework. The hypothesis tested was that the Lean Six Sigma framework can be used to quantify MRI workflow and to identify sources of inefficiency to target for sequence and protocol improvement. SUBJECTS AND METHODS: Audio-video interleave streams representing individual acquisitions were obtained with graphic user interface screen capture software in the examinations of 10 outpatients undergoing MRI of the liver and 10 outpatients undergoing MRI of the knee. With Lean Six Sigma methods, the audio-video streams were dissected into value-added time (true image data acquisition periods), business value-added time (time spent that provides no direct patient benefit but is requisite in the current system), and non-value-added time (scanner inactivity while awaiting manual input). RESULTS: For overall MRI table time, value-added time was 43.5% (range, 39.7-48.3%) of the time for liver examinations and 89.9% (range, 87.4-93.6%) for knee examinations. Business value-added time was 16.3% of the table time for the liver and 4.3% of the table time for the knee examinations. Non-value-added time was 40.2% of the overall table time for the liver and 5.8% for the knee examinations. CONCLUSION: Liver MRI examinations consume statistically significantly more non-value-added and business value-added times than do knee examinations, primarily because of respiratory command management and contrast administration. Workflow analyses and accepted inefficiency reduction frameworks can be applied with use of a graphic user interface screen capture program.

Implementation of graphic user interface screen capture solution for workflow assessment of abdominal MR examinations valuable tool to analyze discrepancies in expected and experienced MR table time.

RATIONALE AND OBJECTIVES: The aim of this study was to assess if graphical user interface screen-capture software applied to a magnetic resonance (MR) hardware console could nonintrusively allow the analysis of discrepancies between expected and experienced MR table time. MATERIALS AND METHODS: Individual MR examination acquisition processes were captured in audio-video interleave streams for 10 patients who underwent comprehensive liver MR imaging. These audio-video streams were dissected into periods of true image data acquisition, scanner activity without direct image data acquisition, and scanner inactivity. RESULTS: Total expected time required for standardized liver MR image acquisition was estimated at 15 minutes. Experienced table times varied highly, ranging from 19:00 to 58:08 minutes. Image data acquisition occurred during approximately 58% (range, 43.3%-73.7%) of overall table time. Image data were obtained approximately 77% (range, 65.6%-87.0%) of the time the scanner spent active. CONCLUSION: Graphical user interface screen-capture software installed on an MR console nonintrusively revealed significant periods of table time spent not obtaining true image data and explained discrepancies between expected and experienced MR table times. Table-time calculations using Digital Imaging and Communications in Medicine image headers and scanner-logged time stamps are underestimations of true table time because they do not take into account some scanner activities not directly leading to image formation.